How Inequities Fueled the COVID-19 Pandemic – And What We Can Do About It

Partnerships Were One Key to the Health Response, Public Health Experts Say During Panel Discussion

By Brandon R. Reynolds

COVID-19 has exposed many vulnerabilities in our society – fueling the spread of the virus and leaving questions about what comes next as the world emerges from the pandemic.

A panel of health experts and government officials addressed the myriad issues related to COVID-19, including health disparities before and during the pandemic, public partnerships, and how communities can better address inequities to prevent the next crisis.

The March 16 panel discussion included health experts from UC San Francisco and officials from the health departments of San Francisco and Alameda counties. The virtual event was the second of a three-part series, titled “COVID-19: The Path Forward.”
“The pandemic exposed the many vulnerabilities in our society, our inequities along age lines, along economic lines, along racial and ethnic lines,” said Kirsten Bibbins-Domingo, PhD, MD, MAS, Chair of UCSF’s Department of Epidemiology and Biostatistics, and moderator of the panel discussion. “These were all factors that fueled the spread of the virus, and then led to disproportionate harms to these same communities that also were experiencing the effects of the economic crisis.”

Nicholas Moss, MD, MPH, Health Officer for the Alameda County Public Health Department, said that there’s the pandemic that affects communities of color and health care workers, and then there’s the pandemic, less severe, that affects affluent communities.

An early sign of the racial and ethnic inequities emerged early-on in San Francisco at Zuckerberg San Francisco General Hospital and Trauma Center, said. Carina Marquez, MD, an assistant professor of medicine at UCSF. She said she saw that the majority of COVID-19 patients were Latino – many health workers or families of health workers. “It was very striking, and it was very early on,” she said.

An early UCSF partner was the Latino Task Force. Marquez said that UCSF brought testing and data collection, while the Task Force designed and led community outreach. “We have all learned to dance together,” said Jon Jacobo, the Task Forces’ Health Committee Chair. “At first there was a lot of stubbing of toes, but I think at this point, we can waltz, we can do some bachata, we can do a little bit of salsa, we can do it all.”

Jacobo said that community partnerships often start not with organizations meeting, but with individual health care workers reaching into communities with harm-reduction goals. “When you have those relationships, it allows the bridge of trust to be expanded a little bit,” he said. “Every time they’ve said they’re going to do A, B, and C, they deliver.”

Community partnerships also enable institutions to address blindspots, said Naveena Bobba, MD, MPH, Deputy Director of Public Health in the San Francisco Department of Public Health. “No one institution is going to get us through the pandemic.”

“We’re wholly reliant on community partnerships to reach our community members,” said Alameda County’s Moss. “We just didn’t have that presence and that workforce, those resources, of the health care delivery system. … I don’t think there’s any way that we would have any success at all if we didn’t have those partnerships.”

Those partnerships enable institutions to recognize, for example, that many people with COVID-19 couldn’t afford to stay at home because of income lost. It wasn’t just about quarantining; there were financial considerations as well.

That’s where a community wellness team would come in, said Jacobo. UCSF can handle testing, and if you test positive, he said, you get a box of culturally relevant food, cleaning supplies, help in the hotel where you’re staying, plus financial resources for people who couldn’t work. UCSF, county health departments and community organizations like the Latino Task Force, were able to work hand-in-hand, to cover a wider range of human need.

During the pandemic, health professionals leaned into partnerships that already existed for other purposes, said Kim Rhoads, MD, MPH, Director of UCSF’s Office of Community Engagement and Associate Director for Community Outreach and Engagement, UCSF Helen Diller Family Comprehensive Cancer Center. Rhodes said that there were already community partnerships in place at the Cancer Center with Black and Asian-American groups, but that the demands of the pandemic forced them to shift focus – from cancer to COVID-19.

As we begin to emerge from the pandemic, we need to recognize the inequities that emerged and, rather than returning to business as usual, address these issues – keep pushing for change, the panelists said.

Institutions must do “year-round, non-transactional community engagement,” Rhodes said.

“And so, if we maintain that kind of relationship where folks can turn to us and ask, ‘I have this problem and not sure how to solve it,’ we may not know how to solve it, but we certainly know a lot of people with a lot of resources,” Rhodes said. “We need to maintain that even during calm times and when there’s no emergency going on, because that’s going to allow us to flip the switch the way we were able to do in the Cancer Center ... and say, ‘Okay, we’re doing something different now because we’re all concerned about this together.’”

The partnerships coming out of COVID-19 have the potential to look at larger, more systemic issues as well.

“One of the things that keeps coming up, and as we move forward something we make sure we build in, is really ensuring access to health care in general,” said Marquez. “It is a critical piece that we need to think about moving forward. It goes back to the community partnership and engagement. The community has been there for a long time, working with populations that have not been engaged in care. That’s already in place. Ongoing partnerships need to think about linkage.”